Saturday, Sept. 21- Sunday, Sept. 22: Ingenuity, our first prosthetic fitting and Sunday rest...

On Saturday, we got to the clinic a little after 7am to start working. 

Protashow and I going over plaster modifications for a below knee prosthesis. I'm the first to tell you that I'm not a teacher, but Protashow and I have been working on a good teaching/learning way of doing things. He has lots of study material and books that we've given him and then practical application happens during our trips.

Graham getting a PVA bag ready for a lamination. It was so awesome to have a technician on the team this trip! I learned a lot from him and Andy throughout the trip. It's always cool to work with new people and learn different ways of doing things. 

Andy and Graham made a second lamination jig out of a pylon we use for a prosthesis and nozzle from the air compressor. Here I'm using wood screws, washers and cord to make a system to hold the lamination bottle. We got creative and it paid off! Two lamination stations meant double the output since we knew we were pressed for time to get all the laminations done. 

Andy and I talking over design for a below knee prosthesis. We were using some attachment components in a little more unique way to decrease how many laminations we needed to do. (Some attachment components require a double lamination for a prosthetic socket while others are only a single lamination.) During the course of the day, we started questioning whether we'd have enough resin to make all the prostheses. We did some calculating and prioritized which prostheses needed to be made and which patients we may need to put off until next trip if we ran out of resin. And then most importantly, we prayed over the resin that God would make it last to get everything made.

I was determined to get the sewing portion completed on Saturday (which I did not). Here I'm measuring out and cutting the fabric that will be sewn into the "sail" part for prosthetic socket. Many of the above knee prosthetic sockets we make are a CJ socket design, which uses a cloth portion on the back of the thigh (the "sail") to give the patient the ability to adjust the prosthesis themselves for best fit. This is a good option for our patients in Zambia.

Traci making the shoe lift for Beauty on a pair of shoes we selected using the tracing and measurements that Andy took when we were screening patients in Choma.

We got almost all of us in one picture working on our tasks. I'm working on cutting out sail fabric, Traci is getting a plaster model ready for lamination, Andy and Graham are working on laminations and Protashow is smoothing a prosthetic socket on the sanding machine. Amanda was in the room with the doorway to the left...

...making buckles and burning holes for the attachment screws. 

Traci using my hand for sizing as she made a strap with attachment for a spoon for our patient, Friday. He has upper extremity finger amputations, which makes it difficult for him to feed himself. 

Traci came up with a great design that he can wrap around his hand, use his teeth to secure the strap and the spoon fits in an elastic band. 

We also had 2 patients at the clinic on Saturday. This is Gilbert, who we made a below knee prosthesis for in September 2018. We made some repairs, gave him new supplies and made sure we have his contact number to have him come in April for us to make him a new socket since his is large now that it's a year old. 

And Luyando came back for fitting of her new above knee prosthesis. When she and her mother came to the clinic on Saturday, we were finishing assembling her prosthesis. What a quick turnaround! We casted her on Friday morning and had it completed and fit by midday on Saturday. 

I asked if we could take a photo together, so she was striking a pose. 😁 She's been coming for prosthetic care since 2014, so it's been cool to be able to see her and her mother each trip. She knows more English now, which makes it much easier for us to communicate. (My knowledge of Tonga is still super basic.)

Amanda helping cut out all the pieces for the "sails". She helped me with this last April as well and commented that she was much faster this time.

Laminations, laminations! 

And a goofy pic

Here's a great close up of the carbon braid material that is used to laminate a prosthetic socket. Carbon is very strong and lightweight when used in a lamination, which makes it a great material for prostheses. 

On Saturday afternoon, Amanda, Andy and Graham went down to see Kid's Club at the orphanage. Kid's Club happens every Saturday afternoon with play time, bible stories and singing, then a meal for kids who come from the surrounding areas. 

There was a lot going on at the clinic and at New Day on Saturday, so it was great that Andy, Graham and Amanda could spend a little time with the kids at Kid's Club.

At the end of the day on Saturday, there were 14 laminations left to do. The electricity went off on schedule at 6pm, so we called it a day after that. 7am-6pm...whew! Lots accomplished on Saturday. We had a team meeting of sorts and determined we felt like we were at a good place on fabrication, so we would take off Sunday afternoon after church for rest. 

On Sunday morning before church, we found out the load shedding schedule had changed to increase from 6 hours to 8 hours a day off. However, there seemed to be conflicting information different people got on what the actual schedule was. So far in the trip, aside from the miraculous day the electricity only went off for about 10 minutes when it was supposed to be off all afternoon, the load shedding was following the schedule pretty well. During the time at the clinic when we would be laminating, it was pretty important to know if the electricity would be going off. 

Church was Sunday morning and then we rested in the afternoon. The electricity was off from 1pm to 7-something pm (so not following the new 8 hrs off it was supposed to). Andy and Graham had brought treats for the New Day kids, so we all walked down to see the kids in the afternoon and hand out goodies. Candy, beads for the girls and toy cars for the small boys.

I also brought a book for Justin (who my husband and I sponsor), so got to give that to him. He's still super shy around me and hides behind the other kids most of the time, but Papa Wes made him take a picture with me. :)

We got in lots of visiting with New Day staff on Sunday afternoon, which was so nice! And Teacher Carolyn cooked dinner for us! We were thankful for the Sunday rest and were planning for an early start on Monday morning at the clinic.

*Next post: Monday, Sept. 23- Tuesday, Sept. 24: Finishing fabrication and more patients!

Monday, Sept. 23- Tuesday, Sept. 24: Finishing fabrication and more patients!

Monday morning was another early start at the clinic. Andy and Graham were trying to finish all the rest of the laminations as we were needing to have everything completed by the end of Tuesday for Wednesday and Thursday fittings. We also had 2 more patients come on Monday to the clinic.

Vincent is a young boy who is neurologically involved, likely cerebral palsy but do not know the exact diagnosis. Here Amanda is working with his mother on exercises for them to do at home. Traci was also able to fit him with AFOs (ankle foot braces) that will help with positioning and providing stability for him to stand. He really needed a pediatric walker, so we got their contact information to call them if we could get a pedi walker for him and to also be able to follow up with them in future trips. 

So cool to see 2 lamination work stations! These guys were so awesome!

Traci sewing straps for the prosthesis for her patient Friday, who she also made the hand strap for holding the spoon.

Here I'm working on repair to Christopher's above knee prosthesis. He came to the clinic for check up and some repairs. We did some modifications to the socket to fit better, but I made sure Protashow has his contact information to be able to see him in April for a new socket. 

Amanda was able to work with Christopher on gait training. He wasn't bending the prosthetic knee when walking since he didn't feel confident and safe. After some therapy, he was walking very well!

Working in the clinic. Amanda had this fantastic cooling cloth that helped cool her down during the heat of the day. (I definitely want to get one of those)

Protashow worked with Andy and Graham on some laminations to get more instruction on this step of the process.

Lamination instructions.

It was great the Protashow could get more instruction from Graham, as a technician, on the lamination part. 

Amanda drilling holes in a finished socket for the attachment screws for the cloth sail portion to be attached. 

Traci cutting out a finished socket after lamination. The arm sleeves she's wearing (and Amanda in the previous picture) are to protect their skin from the itchy carbon dust.

I'm assembling locks in the prosthetic sockets. 

Graham and Protashow working on the last lamination. The resin lasted to get everything laminated!----like the loaves and fish. God provided, and there was even a little bit left over. 

Monday wrapped up with a beautiful sunset view from the clinic. The electricity was on most of the day, with the exception of about 10 minutes during the day. It was scheduled to go off at 9pm but went off at 7pm instead. The differing load shedding schedules plus the outages not following any schedules we had heard was incredibly confusing.

Tuesday was assembling prostheses and getting the clinic ready for patient fittings on Wednesday and Thursday. Here Amanda is attaching a sail to the prosthetic socket with screws.

Traci getting all the plaster models broken out and cleaning up this area. You can see our much needed generator in the picture.

Our rolling carts of finished sockets. Andy is working on putting lock mechanisms in the sockets that needed locks. 

Protashow smoothing the edges of a finished prosthetic socket.

Gray came to the clinic on Tuesday for new shoes. He has a foot deformity that makes it impossible to wear normal shoes. We had brought orthopedic shoes for his left foot and were able to give him several shoes to last him a while. He is not able to tolerate any attempt for correction or support of his foot, so he simply needs shoes that will accommodate his foot deformity.

The electricity had come back on at 10pm Monday night and stayed on through the day, which was great for us to be able to complete all the fabrication. It went off again at 6pm on Tuesday. 

On the way back to the Ark after working on Tuesday, we stopped to climb the water tower for sunset pictures and a great view.

Nurse Carol took a group photo of us from the ground. (Traci had opted to not climb the high tower)

I always love climbing the water tower for some calming sunset views during the trip.

A beautiful view to end our day on Tuesday. We were ready for patient fittings for Wednesday and Thursday.

Tuesday evening after dinner, we got a great surprise treat! Laurie and Wes had made homemade ice cream and brought it over the Ark after dinner. All the American staff came over for ice cream and visiting in the evening. Such fun and a nice cool treat!

*Next post: Wednesday, Sept. 25: Patient fittings Day #1

Wednesday, Sept. 25: Patient fittings Day #1

Wednesday started with a class field trip from Nurse Carol's kindergarten class at the clinic before patients arrived. 

Andy giving the class a tour of John's room where we had all the finished prostheses with each patient's supplies stacked around the room.

They also went in the storage room to see all the supplies. 

Wednesday were patients from the Macha area plus Daniel, who Traci had told to come back on Wednesday. We had 4 patients for fittings---Trywell, Moomba, Daniel and Ozia, and Killion's brother came by to pick up his new prosthesis. (We don't usually let someone just pick up a prosthesis without us doing a fitting, but Killion is a truck driver and was not able to come back for fitting. He will go by the clinic and have Protashow do a check up next time he's in the area. Definitely an unusual situation, but he did need a new prosthesis and we're only there for a few weeks....so we did what we had to in a pinch.) 

Trywell walking with his new prosthesis. He needed a new socket since he has grown, and new knee and foot since his old ones were broken. 

He's as tall as me now! And likely will be taller than me next time we see him. We've been seeing him since 2014, though last time we saw him was April 2018. It's crazy how much he's grown up since then.

Daniel came for fitting of a new right prosthesis. His left prosthesis that was fit in April 2019 was fitting well. 

Daniel is doing well with his walker and both prostheses. He was fit with a right prosthesis only in September 2018 while the left side was still healing. Then fit with a left prosthesis in April 2019. So, he needed a new socket on the right side this time. He's had time to get used to walking with bilateral prostheses, so it was nice that he was at the clinic at the same time as Moomba, who was getting his second prosthesis for the first time on Wednesday. 

Andy assessing a walker for Moomba to use.

We found Moomba a standard walker to use instead of a rolling walker (right side of the picture). Here Andy is working on fitting him with his left prosthesis. We had fit Moomba with his right prosthesis in April, and he had his left amputation since then. 

Everyone on hand for helping Moomba stand with both prostheses for the first time.

He did remarkably well for having bilateral prostheses. He will likely need to continue using a walker to get around, but having prostheses and being able to do some walking will be tremendous help for him at home.

He came on the back of a motorbike (yes, holding onto the driver without legs to stabilize him on the bike). We initially tried to help him get the prostheses on the foot rests, but he was having difficulty. 

So, he requested we just strap the prostheses on the back of the bike with the walker, and he could ride home like he came. Definitely the most interesting completion of a prosthetic fitting! We actually had to do this for Daniel when he first got his prosthesis, but now Daniel has gotten used to using the prostheses while on the motorbike.

Ozia also came for prosthetic fitting. She got a whole new prosthesis with a really great foot that was donated by Freedom Innovations (manufacturer of prosthetic components).

Here she's examining the prosthesis since she could really tell a difference in how the foot functions compared to her old prosthesis.

 Ozia is a greater walker with her prosthesis, so just had to check alignment and fit without need for any training. 

Few small alignment changes for her prosthesis, and she was good to go! I'm anxious to see how the new prosthetic foot holds up for her. She does A LOT of walking on the rugged terrain.

In addition to our prosthetic fittings, Amanda had two patients come to the clinic for physical therapy only. Fostina and Carol had brought up a picnic lunch for us, so we all lunched together at the clinic before closing up for the afternoon. We had only a few patients on Wednesday, so it didn't take all day. We rested in the afternoon some, got to watch dancing practice for the wedding party for Melvin's wedding that's coming up (he's a teacher at New Day), and Andy and Graham played with the kids. After dinner, we went to Praise and Worship with the New Day kids....the older kids take turns leading. There's prayer, praises and concerns, and singing. 

We knew Thursday was going to be a crazy busy day with the rest of the patient fittings (20 people total). 

 *Next post: Thursday, Sept. 26: Patient fittings Day #2